[T]hat’s the underlying reality of health-care reform. Substantive compromise is easy. In fact, the bill is a substantive compromise. It’s a deficit-neutral, universal-coverage scheme that relies on the private insurance market and looks like one of the Republican alternatives from 1994. What’s hard is political compromise. Because there, the two positions are that Democrats are helped if a bill passes and Republicans make gains if a bill fails. There’s no way to split the difference between those positions.

The distinguishing feature of the budget conversation, however, is that it happens at a very abstract level. This red line needs to come down to meet this black line, and this huge number needs to eventually become this slightly-smaller number. That’s all fine for a floor speech, but when you start trying to muscle the red line into position or subtract from the very big number, things get real specific, real quick. Suddenly, you’re telling seniors that there are treatments they just can’t get and you’re telling workers that the insurance system is going to have to change. And just as Conrad doesn’t have much appetite for doing that to his constituents on the small things that most of them don’t notice, very few legislators have demonstrated much appetite for doing this to the country on the big things that pretty much everyone notices.